Healthcare Provider Details

I. General information

NPI: 1487602959
Provider Name (Legal Business Name): RHEMA SOUTHGATE OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 TRENTON RD
SOUTHGATE MI
48195
US

IV. Provider business mailing address

17515 W NINE MILE RD SUITE 925
SOUTHFIELD MI
48075
US

V. Phone/Fax

Practice location:
  • Phone: 734-284-4620
  • Fax: 734-284-0851
Mailing address:
  • Phone: 248-569-8400
  • Fax: 248-569-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number824290
License Number StateMI

VIII. Authorized Official

Name: SHANNON M HACK
Title or Position: CFO
Credential:
Phone: 248-569-8400